Health Care Delivery System

The types of managed care are differentiated by definition, operation, structure, and information needs. `HMOs were the most common type of MCO until commercial insurance companies developed PPOs to compete with HMOs' (Douglas, 2003, p.331). `HMOs are business entities that either arrange for or provide health services to an enrolled population after prepayment of a fixed sum of money, called a premium' (Peden, 1998, p.78). There are three characteristics that an HMO must have. The first is a health care financing and delivery system that provides services for members in a particular geographic area. Second, is ensured access to a complete range of health care services, health maintenance, treatment, and routine checkups. Last, health care must be obtained from voluntary personnel that participate in the HMO. The five HMO models related to the participating physicians are the Staff

rehend the PPACA, one must understand the history of the United States’ health care system. The most successful and known reform would be the passage of Medicare and Medicaid. President Johnson’s main objective with his program was to provide health insurance to those over 65 years old, who otherwise wouldn’t be able to receive coverage due to retirement or being financially unfit to purchase health insurance. It has since been expanded to cover those with disabilities, and lower income families (“Overview,” 2015). Brady (2015) examines President Clinton’s attempt to massively overhaul health care in the United States. His plan, the Health Security Act (HSA), required employers to offer health insurance to their employees, and mandated that every US citizen purchase health insurance. This plan would have most likely expand health insurance to many more Americans; however, many feared the large tax increases, restricted options for patients, and with the lack of general support for the bill, it failed in Congress and was never implemented (p. 628). President Clinton’s failed attempt at health care reform opened up the door to future reforms, and it even shared multiple similarities to the PPACA. Smith (2015) updates the history of the health care system in America stating that “In the mid-2000s, America’s uninsured population swelled to nearly 47 million, representing about 16 percent of the population” and how “16 million Americans […] were underinsured” (p. 2). People

In 1993 First lady Hillary Clinton was assigned to a proposal to reform healthcare with the goal to become universal by US president Bill Clinton, this reform was titled Task Force on National Health Care Reform (Boundless, n.d.). At that time, 37 million Americans did not have health insurance and the cost to obtain health insurance was very unaffordable to the middle class (Boundless, n.d.). The main purpose of this reform was to mandate employers to provide health coverage to all employees HMOs’. However, this reform was aggressively opposed by the health insurance industry, libertarians, and conservative republicans stating that it was restrictive to the employees choice (Boundless, n.d.). Additionally, they argued that the proposal a

The New York Times printed an article by Robert Pear, which reported that on December 24, 2009, the US senate passed the first bill, which would call for major reform regarding health care in the United States (Pear). The article titled “Senate Passes Health Care Overhaul on Party-Line Vote,” discusses the fact that while this step was a major milestone in the process of providing Americans with affordable heath care, it was not the end of the road. Over the coming months and years there would be a lot of give and take between democrats and republicans to revise the bill to the point where both sides could support it. One of the major points in this reform is that the US government was now going to offer affordable plans including subsidy options which would allow more Americans affordable options which were

Expansion of the MCO model occurred with the enactment of the Health Maintenance Organization Act of 1973. This Act provided the foundation for managed health care and required employers with greater than 25 employees to provide and HMO offering. The Act served to counter Democratic efforts to nationalize U.S. health care and to stimulate competition within the health care market. HMO’s also began the concept of for profit health care operations. While most health care providers are not for profit (Phelps, 2011) and number operate under a for profit model. Non-profit dominates the healthcare sector based on their tax exempt status.

Managed care has been adopted into the government funded care organizations. Medicare managed care plans provide all coverage themselves, including basic Medicare coverage. Managed care plans cover above and beyond the basic benefits of Medicare, the size of premiums and copayments, and the decisions about paying for treatment are controlled by the managed care plan. The basic premise of managed care is that the member/patient agrees to receive care from only a specific doctors and hospitals, in exchange for reduced healthcare costs. Medicare, like other insurance companies offer plans that give Medicare beneficiaries more choices in coverage, like HMO or PPO. Managed care has been used since the mid 1990’s in order to provide healthcare to beneficiaries with serious or life long illnesses. Today, managed care has become a way for states to provide quality care to both Medicaid and Medicare patients.

The health care reform debate between 2008 and 2010 led to the passage of Patient Protection and Affordable Act. It was reminiscent of opportunities for reform that have occurred on a cyclical basis throughout American history. These opportunities occurred most notably in the presidential administrations of Franklin Roosevelt, Harry S. Truman, John F. Kennedy, Lyndon B. Johnson, Richard Nixon, and William J. Clinton. (Rich, Cheung, Lurvey, 79). We have to look at recent opportunities that have expanded today.

Hillary Clinton’s health care plan, informally nicknamed “Hillarycare” by its opponents, was authoritatively known as the failed Health Security Act (HSA) of 1993. Clinton, the president’s wife during this particular administration, proposed this healthcare reform package. This reform created a task force to oversee the project in order to make sure that things were going in the proper direction. The primary goal of the Health Security Act was to propose a comprehensive plan to provide universal health care for all Americans to those that could not afford it or if it was not being offered through their place of employment. This plan is similar to what we know as Obamacare today. The dream that was once held in high regard by President Clinton and his wife came crashing down in just a matter of minutes.

U.S. health care reform is currently one of the most heavily discussed topics in health discourse and politics. After former President Clinton’s failed attempt at health care reform in the mid-1990s, the Bush administration showed no serious efforts at achieving universal health coverage for the millions of uninsured Americans. With Barack Obama as the current U.S. President, health care reform is once again a top priority. President Obama has made a promise to “provide affordable, comprehensive, and portable health coverage for all Americans…” by the end of his first term (Barackobama.com). The heated debate between the two major political parties over health care reform revolves around how to pay for it and more importantly, whether it

Other developed countries, such as Germany, Austria, Hungary, Norway, Britain, Russia, The Netherlands, Sweden, France, and Switzerland, all had socialized or nationalized healthcare as late as 1912. The primary reason for the emergence of these programs in Europe was income stabilization and protection against the wage loss of sickness rather than payment for medical expenses, which came later (pnhp.org). In the United States during this time, federal regulation of health care programs was nonexistent; states were given the responsibility and right to regulate within themselves and to determine what- if any- programs were available to their

Less than a hundred years ago, in the late 1920’s and 30’s, almost 90% of Americans did not have health insurance (Fall of HMO’s 4). They used a variety of home remedies and when medical assistance was truly needed, they paid for it out of pocket, even incurring vast amounts of debt. This had been the case throughout history, and it changed due to an important factor, medical equipment. The industrial revolution finally caught up with the medical industry and the country saw a vast change in the scientific instruments used by physicians. These instruments required a lot of money to make and care for which caused prices to rise. Due to this massive problem, a committee was formed of health care professionals and after a 5 year study, the Committee on the Cost of Medical Care suggested that health insurance co-operatives start. These corporate medical practices became known as Health Maintenance Organizations (HMO’s) and preferred provider organizations (PPO’s), and up until the 1970’s, were an experiment to regions across the U.S. Factors that hindered health care included bullying of “money politics” from both sides of the isle as well as Presidential views and tactics as well. President Nixon first

HMOs multiplied rapidly with the new federal giveaways. Managed care, now including PPOs, mushroomed. Employers initially perceived managed care plans as cheaper than traditional fee-for-service insurance. Gradually, they stopped offering a choice of health plans, making individual policies more expensive. HMOs' penetration of the industry had been subsidized into existence. Government had instituted managed care. Today, while overall quality of patient care remains the best in the world, doctors practice medicine in an increasingly intricate web of rationing and regulations: Physicians are stripped of professional autonomy. As patients wander the maze of managed bureaucracy, costs rise and quality deteriorates. Every American dependent on a third party for health coverage is a potential victim of managed care. And state sponsored management of medicine

When President Clinton was elected in 1992 he was given the task to design a health care reform proposal that provided health care benefits for all Americans. When Clinton was elected the country was suffering from setbacks in the realm of healthcare polices from the previous president. With congress being one of the key players they started to develop plans that would provide universal health coverage ideas with: physicians, large businesses, lawmakers, and many interest groups.

Throughout the first part of the 20th century there was little effort to promote health insurance, but in the second half of the 20th century healthcare became a major concern. Once, Medicare and Medicaid were introduced in 1965 the government along with its citizens took a major step in the progression of healthcare. From then, there was a shift in the privatization of healthcare. This forced many of the lower class to be without health insurance. In 1993, President Clinton with the best of in intentions failed at establishing a universal healthcare system in the United States. Finally in 2006, Massachusetts passed a law that would provide healthcare coverage for all of its state residents. In 2010 the

The United States has no special type of nationwide system of the health care delivery. In order to obtain health care insurance, the individuals must buy it in the private marketplace, or it is given to them by the government . Part of the traditional health insurance plans, permits the unrestricted selection of the health care provider and compensates on the fee for the service basis, recently, it covers less than 30% of all the employees. There are basically two kinds of MCOs: Health Maintenance organizations and Preferred Provider Organizations. About 70% of the employees registered in MCOs. HMO is the health care delivery system that associates